More information on the NCQA accreditation can be found
at http://www.ncqa.org/tabid/631/Default.aspx

www.NNCC.us p 2

NNCC UPDATE

Save the Date!
NNCC’s 8th Annual Conference will be held on November 5-7, 2009
We hope you will join us on November 5, 6, and 7, 2009 at the Radisson Plaza Warwick Hotel, 1701 Locust St. in Philadelphia, Pennsylvania for the 8th Annual NNCC Conference. We will be presenting information on innovative practices that
improve access to health care with an emphasis on meeting the needs of vulnerable populations. We encourage you to attend
the conference, share your expertise with us and learn from your colleagues in the field.
The Radisson is conveniently located within walking distance to the Pennsylvania Convention Center, where the American
Public Health Association’s (APHA) conference will be held on November 8, 2009.
We have blocked hotel rooms from November 4-7, 2009 for conference participants to book at a reduced rate of $189 per
night. Given that APHA is in town, the hotel will sell out, so we strongly advise you to book your hotel rooms now. To make
a reservation, please call 1.800.333.3333 and refer to the “NNCC 2009 Annual Meeting,” or go online at www.radisson.com/
philadelphiapa. For more information on how to register and present, please contact Kate Taylor at ktaylor@nncc.us or go
online to register at www.regonline.com/2009NNCC.

NNCC UPDATE
FROM THE DESK OF THE EXECUTIVE DIRECTOR TINE HANSEN-TURTON
The Wheel of Progress...

I

not laid the groundwork throughout the U.S. in

n a recent trip to Disney World I went on the

positioning the advanced practice nurse to be at

Wheel of Progress. It was Walt Disney’s favorite

the forefront of the debate. Without your sacri-

ride and the most popular one for years. Wheel

fice and hard work over the past many decades,

of Progress takes you through time and shows us

the private sector would not have been as aware

how our life improves over time.

of the role of nurse practitioners and how they

During these tough economic times, we all

can expand access to care.

know that the need for accessible, affordable

Now, the best part of being on the policy

health care for all Americans has never been

radar is that key organizations start paying at-

greater. These days everyone reports frustra-

tention to you. Our new Obama Administration

tions about accessing much-needed health-

has said nursing will play a critical component

care services. All around the nation, policy-

in health care reform, and we will make sure

makers are feeling the consumer pressure to

nurse-managed care is on their radar. Don’t

get access when they want to and when it is

miss Dr. Keckley’s recent report from the Delo-

convenient to them, and they are taking notice

itte Center for the Future. He predicts what you

about the role advanced practice nurses and

already know, that the future of primary health

nurse practitioners can play in improving ac-

care lies with nursing.

and Alexander and Representatives Capps and

cessible, affordable, high quality care. For the

If you haven’t already, pick up a copy of Clay-

Terry to establish a nurse-managed clinic pro-

first time in history policymakers are seriously

ton Christensen’s latest book, “The Innovator’s

gram under the Bureau of Primary Healthcare,

talking about using advanced practice nurses

Prescription.” It provides an incredible insight

Health Resources and Services Administration.

as the solution to alleviating the burden on a

into the architecture of a disruptive innovation in

In addition to progress on the policy front,

strained system, which many now publicly call

healthcare, how disruptive innovations are game

a lot of new and exciting programs are being

a broken system of care or a “non-system” of

changers, and I think you will see how the nurse-

implemented in nurse-managed centers. We

care. This time the nurse’s role is talked about

managed and nurse-led movement has been a

are reporting on many of these programs and

in a much broader sense. Nurses have gradu-

disruption to traditional primary care. We would

services we provide, and I hope you take the

ated from being good enough to take care of

not have seen all the progress in the advanced

chance to read the Update.

the vulnerable, to taking care of everyone!

practice movement without many of you being

That’s progress, as Walt Disney would have

the for-runners and mavericks for change!

said, in the Disney World ride, he was most
proud of “The Wheel of Progress”!
While the buzz is not directly about us or
nurse-managed health centers, I strongly be-

Finally, I want to thank Sormeh Harounzadeh, who was our Independence Blue Cross

Also look for other key studies from RAND,

nurse intern and our wonderful co-editor of

Health Affairs and the California Healthcare

this Update. Sormeh wrote about her experi-

Foundation, where the role of nurse practitioners

ence at the National Nursing Centers Consor-

in primary care roles is being clearly explored.

tium, and there is nothing more gratifying than

lieve that all of you were one of the main cata-

It is also an exciting time for the National

to read about your work through someone

lysts for this change. There would most likely not

Nursing Centers Consortium. For the first time in

else’s lenses and know you have awakened

be a retail clinic movement, had so many of you

history, a bill was introduced by Senators Inouye

their passion. Enjoy!

www.NNCC.us p 6

NNCC UPDATE
Message from the Board of Directors

W

e are very pleased to report the NNCC has

• Genuardi’s Family Foundation

continued to see significant growth in staff

• Pew Charitable Trusts

and programs that support nurse-led health care.

• Children’s Health Fund

This newsletter captures some of these success-

• Institute for Nursing Centers

es. At the core of our success is the willingness

• The Philadelphia Foundation

of everyone in the Consortium to share learning

• The American Legacy Foundation

with one another. The majority of our programs

• Mercy Hospital of Philadelphia

have sprung out of best practices from individual

• The Robert Wood Johnson Foundation

health centers that decided to share the programs

• William Penn Foundation

with the NNCC and make them available to col-

• The Beck Institute for

leagues around the country. We are very fortu-

Cognitive Therapy and Research

nate to have supportive funders. Special thanks

• The Connelly Foundation

to the following partners for funding support:

• The 25th Century Foundation

• Independence Foundation

• The Edna G. Kynett Memorial Foundation

• The U.S. Environmental Protection Agency

• St. Christopher’s Foundation for Children

• The U.S. Department of Health and Human

• The U.S. Department of Health

Services, Region III
• The U.S. Centers for Disease
Control and Prevention
• The U.S. Department of Housing
and Urban Development
• The U.S. Health Resources and Services
Administration
• The Pennsylvania Department of Public Welfare

NNCC UPDATE
Hold the Date for our Southeastern regional workshop!
The Health Center Empowerment Project (HCEP), a HRSA-funded program awarded to NNCC, is comprised of five regional
workshops designed to provide training and technical assistance regarding three key areas:
zz Program management and capacity building for participation in the HRSA health center program;
zz Best practices for health outreach programs; and
zz Maximizing non-HRSA funding sources to ensure long-term financial sustainability.
The HCEP workshops provide training and technical assistance in these areas by helping health centers serving
residents of public housing achieve sustainability, and increase the quality and availability of outreach programs designed to prevent disease and improve health outcomes. The next regional summit is being held in the Southeastern
region - HHS Region 4, representing North Carolina, South Carolina, Kentucky, Tennessee, Georgia, Alabama, Mississippi, and Florida - in Nashville, TN on September 25, 2009.
Our host is Bonnie Pilon, DSN, RN, BC, FAAN, Senior Associate Dean for Faculty Practice, School of Nursing of
Vanderbilt University. At all regional summits, experts will provide trainings and workshops designed to increase
the capacity of health centers to provide high-quality care to residents of public housing. Health center staff will
also have access to an online resource center, an online course, peer mentoring opportunities, conference calls with
experts and face-to-face training sessions.

For more information, please visit http://nncc.us/workshops/HCEP_SE.html

NNCC UPDATE
Colleagues in the News:
The NNCC also runs a Tobacco Cessation

tine addiction, but she offered suggestions

Member Awards and Recognitions

class that I attended. Elizabeth Byrne, the

on stress management and positive overall

PHILADELPHIA

counselor who runs the class, invited me

health choices. She emphasized the impor-

The 11th Street Family Health Services Center of Drexel

to one of her afternoon sessions. The class

tance of exercise and recommended forms

University was selected as a national model for care delivery

was held in a public library meeting room,

of massage therapy. It was a holistic health

by Innovative Care Models, announced Dr. Gloria Donnely,

which led me to believe it would be simi-

approach where both mental and physical

dean of Drexel’s College of Nursing and Health Professions.

larly to elementary D.A.R.E. classes where

aspects of health were addressed. Her ad-

The Center was among just 24 “acute care,” “bridge con-

people are lectured on the negative effects

vice was well received and appreciated by

tinuum” and “comprehensive care” organizations named

of drugs and alcohol. I never expected a To-

a crowd who desperately needed to escape

national models as part of a research project conducted by

bacco Cessation class to impress or move

a deadly habit. It is no surprise that in the

Health Workforce Solutions LLC and funded by the Robert

me, but as the seats filled and the crowd

past year, the program has reached 140

Wood Johnson Foundation.

started talking, the meeting was filled with

people, 69% of whom finished the class and

revelations and connections. People offered

of those finishers, 54% have quit smoking.

each other help and listened to experiences

The past success of NNCC’s programs

that could perhaps help them deal with

has led to their continued funding by the

what they were going through. People excit-

government and other sources. We can only

edly walked in the room with news that they

hope that nurse-managed primary care and

hadn’t smoked in three days or one week

wellness clinics as well as programs such

and were met with applause and genuine

as Lead Safe Homes and Tobacco Cessation

happiness from the rest of the crowd. What

will spread across the United States and be

may seem like a trivial accomplishment to

adopted by other organizations. Our coun-

a non-smoker is actually a world of success

try is in a health care crisis. NNCC’s primary

for someone who wakes up in the middle of

care prevention programs seek to rectify this

the night for a cigarette.

problem on a small scale, but it’s not enough.

Every couple of minutes there was

The problem now is awareness. People may

some coughing in the room that sent chills

still believe in the fatuous claim that nurse

down my spine. Many of the people in the

practitioners are not as qualified as primary

program had been smoking for the major-

care physicians, but there is no denying

ity of their lives and the negative effects

that in order to deter the growing health

were obvious. This was literally their last

disparity, nurses must be better utilized,

chance to overcome the addiction before it

and their scope of practice expanded.

became too late. Two people were already
The Center, which is partnered with Family Practice and

suffering from COPD and many of them

Counseling Network, opened in 2002 through a partnership

said they had trouble breathing. Seemingly

between the North Philadelphia community and Drexel’s Col-

young women had visibly thinning hair and

lege of Nursing and Health Professions that began in 1996.

yellow-stained teeth. It is a morbid thought

It provides a comprehensive range of health services, in-

that some of these people will not be able

cluding physical examinations, diagnosis and treatment of

to quit smoking and will probably die from

illness, family planning, health maintenance and disease

the complications of tobacco use. But at

prevention services, dental, nutrition, physical fitness and

the same time I am optimistic because this

behavioral health.

program is giving them hope.

Its combination of behavioral-health services, which are

Elizabeth was an exceptional counselor.

integrated into daily care to improve the effectiveness and ef-

She was both knowledgeable and compassionate about the topic. Not only did she
give examples of how to overcome a nico-

www.NNCC.us p 15

NNCC UPDATE
Colleagues in the News:

Data Talks

ficiency of treatment, makes the Center unique in Greater Philadelphia. The Center’s transdisciplinary care team comprises a
nurse practitioner and primary behavioral health consultant.
Depending on patients’ needs, the teams may also include a
health educator-nutritionist, physical therapist and dentist.
Using a care team enables disciplines to learn from each other, as each provider learns from the other’s role.

NNCC Data Mart Research Network

T

he NNCC continues to manage a re-

nating research findings. Funded through

search network of nurse-managed

generous support from the Independence

health centers that are collecting data

Foundation and previously the Indepen-

electronically and pursuing research op-

dence Blue Cross Charitable Medical Care

The Center is a one-stop shop for health and wellness. It offers

portunities. Four participating nurse-man-

Program, the research network is con-

patients a centralized location to receive health and wellness

aged health centers went live with the Mi-

sidered a PBRN (practice-based research

services. Its holistic approach augments primary, behavioral

sys electronic medical record in July 2007.

network), registered with the Agency

and dental care with chronic-disease management, health pro-

The mission of the Data Mart Network is

for Health Care Research and Quality

motion and wellness services. In addition to its clinical services,

to build the capacity of nurse-managed

(AHRQ). NNCC staff received a grant in

the Center houses a fitness center, teaching kitchen and other

primary care health centers to collect

August from the Independence Blue Cross

common spaces for health-promotion activities such as yoga,

clinical data, thereby facilitating clinical

Charitable Medical Care Program for re-

cooking classes and family-fitness programs.

research aimed at adopting best practices,

newed funding for the PBRN.

The Center’s target population is medically underserved,

insuring quality patient care, and dissemi-

low-income patients and vulnerable adults with chronic illness in a section of Philadelphia known as the 11th Street
Corridor. The corridor encompasses Spring Garden and Cecil
B. Moore streets and Fifth and Broad streets. More than half

Member Services and Resources

its patients have Medicaid coverage, and an additional 33
percent are uninsured.

We have revised our mission!

zz Foster partnerships with people and
groups who share common goals.

The Center’s director, Dr. Patricia Gerrity, was named an
Edge Runner in 2007 by the American Academy of Nursing.

Vision

Through its “Raise the Voice” campaign, the academy is

Keep the nation healthy through nurse-

tium (NNCC) represents nurse-managed

mobilizing 1,500 fellows, partner organizations and health

managed health care.

health centers serving across the country.

The National Nursing Centers Consor-

Nurse-managed health centers seek to be

leaders to ensure that Americans learn about possibilities
for transforming the healthcare system and that nurses are

Mission

recognized, and thus to be more effective,

helping lead the way.

To advance nurse-led health care

as an integral part of the nation’s health-

through policy, consultation, programs

care delivery system. To fulfill this ambi-

who are on the cutting edge of finding new ways to integrate the

and applied research to reduce health

tious goal, the NNCC Board of Directors

mental and physical health of patients. Gerrity, Ph.D., RN and

disparities and meet people’s primary

and staff are currently implementing a

FAAN, has served as associate dean of community programs in

care and wellness needs.

4-year strategic business plan to guide the

The Edge Runner award recognizes nursing professionals

Consortium’s future growth and foster the

Drexel’s College of Nursing and Health Professions since 1996.
NNCC Named Edge Runner
by American Academy of Nursing
The National Nursing Centers Consortium was recently named

NNNC Goals

success of its members. The business plan

zz Provide national leadership in identi-

strategies include:

fying, tracking, and advising healthcare policy development.

Edge Runner by the American Academy of Nursing through

zz Position nurse-managed health cen-

its “Raise the Voice” campaign for nursing. Other NNCC mem-

ters as a recognized, cost-effective

bers have received a similar recognition.

mainstream health care model.

zz Enhancing our voice in shaping state
and national policy;
zz Fostering organizational growth; and
zz Strengthening member center capacity
and sustainability.

of Nursing grant entitled “Building RN Training Skills
for Geriatric Nursing Excellence” directed by Eileen
M. Sullivan-Marx, PhD, FAAN, CRNP, Associate Dean
for Practice & Community Affairs. The purpose of
this grant which was funded through the Nurse Reinvestment Act was to develop learning modules for
registered nurses (RNs) in geriatric long term care
settings through a training program for RNs that will
provide them with the requisite skills to educate licensed practical nurses (LPNs) and certified nursing
assistants (CNAs) in competencies for comprehensive geriatric care excellence. Sullivan-Marx and her

www.NNCC.us p 28

On the Road With Nurse-Managed Health Centers
education, and cultural competence to develop and

geriatric care team, enhance team morale, improve

given learning need variation by setting and diver-

test learning modules for nursing and professional

care, and increase retention of all nursing staff.

sity within groups; participants need opportunities

staff in several long term care settings including the

Despite enthusiastic support by administrators in

(freedom of disclosure) to share personal stories/is-

School of Nursing’s LIFE Program.

the long term care settings and the School of Nurs-

sues resulting in critical thinking; and follow up is

The University of Pennsylvania School of Nurs-

ing’s LIFE Center, the training team was challenged

needed to debrief on issues that may only skim the

ing’s Center for Professional Development had ini-

by scheduling difficulties and availability of staff to

surface, e.g., conflict resolution. Nurse participants

tially developed 4 of the leadership training modules

be trained either on or off site. Shortages of nurs-

were especially interested in case based information

for acute care settings that were revised and used for

ing staff and the lack of dedicated time in clinicians’

and training in management/conflict resolution; im-

this project. Pilot participants stated the there was

schedules for training by a center hampered initial

plementing training and dealing with system issues.

a need for RN educational programs on leadership

start of training. Valuing training of clinical staff in

Full or half day courses were preferred over two hour

and management since the majority of participants

issues of leadership and management is a gap in

blocks of time. As program developers, we gained a

(80%) had received none or insufficient content in

both long term care and primary care, the research-

heightened appreciation of the extent and nature of

their basic nursing education programs. Many stated

ers found. With persistence and administrative sup-

management needs and the difficulties associated

they needed to “learn on the job” with no skills in

port, and as training began, the flow of training

with having those needs met.

leadership or management and were unprepared for

improved as participants were engaged and excited

After the first three years of funding, Sullivan-Marx

the role as staff nurses and nurse managers work-

about skills that they were learning. A strong take

and co editor, Deanna Gray-Miceli published the learn-

ing with many diverse health care providers. Center

away message of this project is the need for nursing

ing modules in a book “Leadership and Management

for Professional Development conducts ongoing

and administration to place value on management

Skills for Long Term Care” published by Springer Pub-

needs assessment with each continuing educa-

and other training and to build this in to schedules

lishing Company, LLC, with an accompanying website

tion program. Content for registered nurses to learn

and expectations in the work site.

for training materials. Current funding is focused on

leadership and management are requested by 30%

All modules were highly rated and nurse partici-

development of half-day workshops in team building,

of the 1000 annual participants in survey needs as-

pants indicated that their confidence in knowledge

negotiation, change process, adult education, and

sessments in the last three years.

of clinical topics was greater than their confidence

cultural competence for leadership. Promoting health

The project also focused on centers and agen-

in managing educating others even though their

for older adults and emergency preparedness in nurs-

cies that had a diverse workforce and served minor-

jobs called for them to be doing so. Lessons learned

ing long-term care centers are now being tested in

ity aged individuals to improve interaction with the

in the process are that teacher adaptability is key

several centers including the LIFE Program.

www.NNCC.us p 29

On the Road With Nurse-Managed Health Centers
Texas

News from the University of Texas Health Services (UTHS), Houston

W

ith the promotions of Thomas Mackey, PhD, RN,

Julie Lindenberg, DNP, RN, FNP-BC is the former

filling a much-needed gap after the passing of pro-

FNP-BC, FAAN, FAANP to the Associate Dean for

Director of the Family Nurse Practitioner program at

lific nurse researcher Frank Cole, PhD, RN, CEN, FNP,

Practice at the University of Texas School of Nursing

the University of Texas School of Nursing at Houston

FAAN, FAANP, in 2006.

at Houston and Elizabeth Fuselier, DNP, RN, FNP-BC

and a 2007 graduate of the Doctor of Nursing Prac-

Recently, the clinic has also added Kristi Edmon-

to the acute care setting in the position of Chief of

tice program at Columbia University. Lindenberg has

sond, RN, Executive Assistant, Sherry Snook, medical

Advanced Practice Nursing at the University affiliated

been practicing at the clinic since 1992.

assistant, and Lori Ibarra, receptionist, to its already

Hospital, Memorial Hermann, a new Director was appointed to the Nurse-Managed Health Center.

Cathy Rozmus, PhD, RN is also a welcome addi-

strong team.

tion as a part-time nurse researcher for the Center,

Building the Case for a Nursing-managed Clinic: The St. Vincent’s Nurse-Managed Health Clinic
by Kathryn Fiandt, DNS, FAANP, Associate Dean for Graduate Programs and Clinical Affairs, University of Texas Medical Branch School of Nursing

U

niversity of Texas Medical Branch (UTMB)

uninsured users were identified as the pool of ap-

fairs, the School of Nursing was invited to develop

School of Nursing will be opening a new com-

proximately 500 uninsured patients with chronic

a proposal for a new primary care practice for these

prehensive primary care clinic this September. The

health problems who were “frequent flyers” in the

patients. A critical component of the proposal was a

St. Vincent’s Nurse-managed Health Center will pro-

emergency room and in the hospital. Here at UTMB

cost analysis or plans for demonstrating a return on

vide care to an ethnically diverse population of un-

analysis of the 2006 utilization patterns of these pa-

investment analysis.

insured adults with chronic health problems and will

tients determined that the patients with a diagnosis

The data regarding hospitalizes was available to

be funded 100% by monies from the UTMB hospitals

of type 2 diabetes and/or hypertension in this pool

us. A current recommendation for analysis of cost

and clinics budget. This amounts to $225,000/year

of patients averaged 1.75 hospital stays per year at

effectiveness for disease management programs is

in fiscal support of the operations of this center. The

a rate of about $13,000 of uncompensated care per

to look at “number needed to avoid”, i.e. number

only In Kind expenses will be the overhead which

hospitalization. This groups of patients, although not

of avoidable health care events (e.g. ER visits or

will be absorbed by the building owner, a community

the major factor in uncompensated care (e.g. oncol-

hospitalizations) needed to avoid to cover the cost

center, the St. Vincent’s House and an estimated 0.2

ogy costs are much higher) were seen as a target for

of the intervention (Linden, 2006). We were able to

FTE in faculty practice. The costs of a full time family

a low cost intervention for which there might be a

determine that given the $225,000 cost of operat-

nurse practitioner, medical assistant, some time for

sizable return on the investment.

ing the clinic and given that each uncompensated

a clinical laboratory science faculty to develop and

As a result of these data two programs were pro-

hospitalization resulted in average $13,000 loss for

maintain the lab, and for practice management and

posed. A year ago, a nurse case management pro-

the hospital, the hospital will breakeven on their in-

evaluation by the office of the SON Assistant Dean for

gram was initiated targeting the identified pool of

vestment in the clinic when we have resulted in 17

Clinic Affairs, are all covered in the budget. In this

chronically ill “frequent flyers”. This program has

avoided hospitalization. Since the actual operating

article I would like to discuss how the SON was able

been going well but hit a “snag” when the nurses

costs of the clinic are probably closer to $300,000

to successfully build the fiscal argument for this in-

discovered that the safety net clinics in the commu-

if overhead and faculty In Kind are factored in, a

vestment in a nursing center.

nity (the local federally qualified community health

more realistic breakeven will be 23 hospitalizations

UTMB, like many academic health centers, has a

center and the internal medicine residents clinic)

avoided, still a realistic goal.

commitment to serving the uninsured and vulner-

were over subscribed and additional primary care

Before we even open our doors it is clear that the

able residents of the community. The fiscal drain of

spaces was needed to provide health care homes

argument for on-going sustainability of the clinic will

these patients on the system is, however, a signifi-

for the patients. As a result of on-going interactions

be based in the data that we collect as a part of the

cant challenge to the need to “balance the books”

regarding the value of nursing centers between the

care we provide. As a result, a comprehensive pro-

every year. There are many reasons for these uncom-

physician director of the UTMB Office of Community

gram evaluation plan has been developed includ-

pensated costs but one subset of the population of

Outreach and the SON Associate Dean for Clinical Af-

ing obtaining IRB approval for the data collection

www.NNCC.us p 30

On the Road With Nurse-Managed Health Centers
process. In addition to traditional outcomes such

be feasible because the costs of the clinic are not

clinic was built solely on the needs of the patients.

as clinical status and patient satisfaction, outcomes

justified based on numbers seen per se, but on hos-

The problem with that argument is that the patients’

that track access to care, health disparities and costs

pitalization avoided, so fewer patients can be seen

needs were in direct contradiction to the need of the

will be carefully monitored. Although the care pro-

and more time given to each patient. Nursing inter-

system to cover the costs of doing business. Finally,

vided will be at no cost, we will capture charge data,

vention data will be collected with each encounter

building on the success of our relationships within

i.e. determine the billable worth of each visit. In ad-

to describe the complex interventions provided that

the academic health center and our sound fiscal

dition, each patient’s history of hospitalization in

will, we believe, result in improved outcomes.

argument, we must follow-through on our commit-

the last year will be determined at intake per patient

There are several critical lessons to be learned

ment by providing quality care and documenting

report and then verified through a review of records

from what we have accomplished and regarding

the value of the services we offer, not just in clinical

for all UTMB patients. It is anticipated that over 90%

what we hope to accomplish. The first lesson is

outcomes or in patient satisfaction, but in demon-

of patients will be established users of the UTMB

the importance of building a relationship with like

strating a cost savings that outweighs the cost of the

health system. At each subsequent visit patients will

minded leaders in the hospital and/or academic

clinic, i.e. the “return on investment”. When we do

be queried about recent hospitalizations and emer-

health system. Our relationships were built on our

that we can be reasonably confident that the system

gency room visits.

shared commitment to providing care to the most

will continue to provide the fiscal support we need
for continuity of our nursing center.

We know that providing access to care alone is

vulnerable of patients and that emphasis overcame

not sufficient to avoid hospitalization, so the clinic is

traditional physician and nurse practitioner bar-

designed to provide “intensive primary care” using

riers in the system. The second lesson is the value

References:

a partnership between the nurse case management

of speaking the shared language of finances. Prior

Linden, A. (2006). What will it take for disease man-

practice and the clinic nurse practitioners with an

to providing a comprehensive analysis of where

agement to demonstrate a return on investment? New

emphasis on self-management support strategies

the system was “bleeding” money and determining

perspectives on an old theme. The American Journal of

as well as traditional medical interventions. This will

the “low hanging fruit”, the argument for a nursing

Managed Care, 12 (4), 217-222.

To learn how to start and sustain Nurse-Managed Health Centers, don’t miss:
Community & Nurse-Managed Health Centers: Getting Them Started and Keeping Them Going,
a National Nursing Centers Consortium Guide, a Springer Publication

For More Information

go to www.NNCC.us

www.NNCC.us p 31

On the Road With Nurse-Managed Health Centers
Washington

After nine successful years of treating patients in the Spokane community, the People’s Clinic closes its doors
by Margaret Auld Bruya, DNSc, ARNP, FAAN, Professor and Assistant Dean, Academic Health Services,
Washington State University Intercollegiate College of Nursing

F

ollowing the recommendations of a blue-ribbon

them with information about other clinics so that

utilized to develop a community partnership model

panel comprised of academic and commu-

they could pursue the care options that were most

of primary health care.

nity experts, the People’s Clinic, a nurse-managed

comfortable to them.”

When the clinic first opened, Bruya anticipated

clinic operated by the Washington State University

The possible closure of the clinic was first an-

serving 120 patients per month; however, the

Intercollegiate College of Nursing, closed its doors

nounced in June, 2007, after the College of Nursing

need was exceptional. Within months of opening,

on May 15. Nurse practitioners at Washington State

was informed that federal funding for the program,

the clinic exceeded capacity and grew from being

University, who worked at the clinic, are accepting

which totaled approximately $400,000 each year,

open two days per week in 1998 to five days per
week in 2004. And, it expanded to three locations
in Spokane and one in Yakima, Wash. In addition,
the clinic provided satellite efforts to provide health
services at Havermale High School, an alternative
high school located in one of Spokane’s poorest
communities.
The People’s Clinic has cared for more than 27,500
unduplicated clients from the Spokane County area
and has provided accessible and affordable healthcare services to the county’s homeless, marginalized, vulnerable, and low-income families. The faculty-directed care of these vulnerable populations
not only supported the mission of the college, but
also helped serve an important educational purpose
for its students.

clinical practice contracts with existing clinics in

would not be renewed effective June 30. Washing-

“The People’s Clinic has performed an important

Spokane. This action will allow the nurse practitio-

ton State University President Elson S. Floyd later

service for many people in Spokane who need ac-

ners to continue to offer services within the commu-

announced that the university would provide bridge

cess to health care,” said Bruya. “It was important for

nity, but without the administrative responsibilities

funding to ensure continued health care for People’s

us to do everything possible to see that the patients’

of operating a clinic.

Clinic patients as they made the transition to other

interests were protected and that transition plans

health care providers.

were put into place this past year.”

“Both care continuity and patient choice were important to us when we decided to close the clinic,”

cal assistance at no additional cost to
its members. Examples of technical as-

These Grand Rounds Online programs

care professionals in the primary care

sistance include assisting health centers

offer more than 110 hours of Category 1

specialties, but also serve as an effective

with applications to become community

CEU and additional lectures will be added

tool for those who wish to broaden their

health centers, conducting site-visits and

sequentially. Each program is

knowledge in areas outside their chosen

meeting with university leadership to dis-

zz Original, evidenced-based, and presented

specialty.

cuss challenges and opportunities, assisting with the development of business and
strategic plans, providing grant writing
assistance and visiting legislators with or
on behalf of member centers.

in the traditional Grand Rounds format
zz Lively and informative, and enabling
you to remain clinically current
zz Accessible 24/7 and available on an unlimited basis

Over 110 fully accredited online Con-

zz Designed to provide up to 1.5 hours of

tinuing Educations Units (CEUs) available

ACCME, AAPA, AOA and ASNA credits

to NNCC members.

if you take the self-administered test at

National Nursing Centers Consortium

the end of each program

Unlike many other CEU programs, the
GEF series accepts no commercial support from pharmaceutical companies or
medical device manufacturers. This important policy preserves the integrity of
the content and the objectivity of the distinguished faculty.
An annual and quarterly subscription is
now available through NNCC at an attrac-

(NNCC) and the non-profit Graduate Ed-

Grand Rounds Online also serves as a rap-

tive professional discount. Before enroll-

ucation Foundation (GEF) have agreed

idly accessible clinical information library.

ing, you may access Grand Rounds Online

to enable our members to benefit from

By going to www.ceulectures.org/nncc

and review any three lectures at no cost.

a series of web-based clinical seminars

and clicking on Grand Rounds Online, you

Please check out this new opportunity

presented by many of our nationâ&#x20AC;&#x2122;s leading

will be able to access the site in real-time

by visiting www.ceulectures.org/nncc

healthcare educators. These interactive

as clinical issues arise in your day-to-day

and click on Grand Rounds Online. I think

CEU lectures, known as Grand Rounds

practice. The Web site and lectures are

you will agree this is an excellent way to

Online, cover a broad spectrum of medi-

structured so that the table of contents

earn CEUs.

www.NNCC.us p 34

NNCC UPDATE
Policy News
111th Congress - Report Language:
introduced a draft version of the Affordable Health Choices Act. This
sweeping 600 page health care reform
bill proposes bold changes that will
transform the nation’s health care delivery system. NNCC is pleased and excited to announce that the bill includes
language that would create a $50 million grant program within the Bureau
of Primary Health Care for nurse-managed health clinics offering primary
care and wellness services to vulnerable populations around the country.
The following NNCC Policy Requests were

The inclusion of this language in

included in U.S. Senate Report 109-287:

Kennedy’s initiative is a tremendous

zz The Committee recognizes the service to

opportunity for nurse-managed health

the uninsured by Integrated Health Cen-

clinics representing the culmination of

ters [IHCs] and Nurse-Managed Health

advocacy activities which began almost

Centers [NMHCs]. These nonprofit

two years ago. In September of 2007,

hospital-affiliated or university-based

Senator Inouye (D-HI) and Senator Al-

health centers provide much needed

exander (R-TN) introduced the Nurse-

primary care to a diverse and disadvan-

Managed Health Clinic Investment Act

taged population. These health centers

of 2007 (S. 2112) calling for the creation

are frequently the only source of prima-

of a federal grant of a grant program for

ry care to their patients. The Committee

NMHCs. On October 9th 2007, NMHCs

encourages HRSA to explore options to

leaders from across the country held a

include IHCs and NMHCs in new public-

legislative briefing in support of this leg-

private safety net partnerships thereby

islation, speaking passionately about the

increasing access for the medically un-

growing role of NMHCs and the need for

derserved. Specifically, the Committee

funding. The briefing was attended by

encourages HRSA to explore granting

approximately 60 people including staff-

these health centers the ability to ap-

ers from the both the House and Senate.

ply for FQHC Look-Alike status. Senate

Although, S. 2112 did not advance

Rept. 109-287 p.38

out of committee, Senator’s Inouye and
Alexander used the momentum gener-

Federal Issues

ated by our 2007 efforts to introduce an

zz On June 16 2009, NNCC experienced a

updated version of the legislation in this

true breakthrough on federal level as

year’s congress. The new legislation en-

Chairman, Kennedy and the members

titled the Nurse-Managed Health Clinic

of the Senate Committee on Health

Investment Act of 2009 (S. 1104) also as

TOP: Dr. Jan Towers and Tine Hansen-Turton; CENTER:

Education Labor and Pensions (HELP)

has a companion bill in the House (HR

Dr.Sally Lundeen; BOTTOM: Ann Ritter and Brian Valdez.

www.NNCC.us p 35

NNCC UPDATE
2754) introduced by Representatives

zz NNCC staff advocated that the Stimulus

expansion of non-physician providers

Lois Capps (D-CA 23) and Lee Terry (R-

Bill include advanced practice nurses un-

to be included in Massachusetts man-

NE 02) on June 8th 2009. Ultimately, out-

der the Health Information Technology

aged care plans.

standing work by Jacqueline Rychnovsky

(HIT) proposed Medicaid and Medicare

in Senator Inouye’s office persuaded the

demonstrations. Ultimately, advanced

Managed Care/Center Reimbursement

Senate’s HELP committee to build lan-

practice nurses were included in the

zz NNCC policy staff worked to develop

guage from S. 1104 into the Affordable

Medicaid HIT component of the bill.

Health Choices Act.

a series of comments in response to
the Pennsylvania Department of In-

NNCC staff are closely monitoring

State Issues

surance’s call for comments regarding

the progress of this month’s hearings

zz NNCC policy staff members worked on

the proposed merger between Inde-

on the Affordable Health Choices Act to

emerging policy issues in Pennsylvania

pendence Blue Cross (IBC) and High-

ensure our language remains a part of

in order to advocate for nurse-managed

mark. While IBC has been a strong

the legislation. The advances made on

health care at the state level. Three

supporter of nurse-managed health

the federal level would not have been

separate bills (HB 1824, SB 5, and

centers in Southeastern Pennsylva-

possible without the tireless efforts of

HB 2625) were introduced that would

nia, Highmark has repeatedly refused

NNCC members around the country.

create funding mechanisms for com-

to credential nurse practitioners as

Now as major heath care reform seems

munity-based health care providers.

primary care providers in the western

a real possibility for the first time in de-

All three of the bills include language

part of the state. NNCC expressed its

cades, we must keep up the pressure

explicitly

nurse-managed

concerns about whether Highmark’s

to take full advantage of this unprec-

health centers as a category of health

discriminatory policies towards nurse

edented opportunity.

providers who will be eligible for fund-

practitioners would expand statewide

ing under the new legislation. In con-

following the proposed merger in of-

nection with these activities, the NNCC

ficial written comments to the Depart-

Policy & Program Strategist traveled

ment of Insurance and letters to key

to Harrisburg to attend meetings with

lawmakers (both Democrat and Re-

legislative staff and testify in front

publican). Subsequently the merger is

including

of the Senate Public Health and Wel-

not moving forward.

fare Committee about nurse-managed

zz NNCC staff and a consultant continue

health centers. Although these efforts

to work with members to get them

were ultimately unsuccessful (none of

credentialed with managed care com-

the three bills were passed), NNCC suc-

panies. Recently, NNCC staff has been

cessfully raised its members’ profile at

working with Sandra Berkowitz, NNCC’s

the state level in Pennsylvania.

nurse-attorney consultant who spe-

zz NNCC developed and submitted writ-

cializes in insurance issues, to help

ten comments to state policymakers

Independence Blue Cross implement

in Massachusetts and Pennsylvania

a plan-wide policy recognizing NPs as

about regulatory changes that would

primary care providers.

ABOVE: Tine Hansen-Turton and Congresswoman Lois Capps;

impact NP primary care providers. The

NNCC presented Capps a 2008 Champion Award.

outcome was a bill, which include the

www.NNCC.us p 36

NNCC UPDATE
Insurers’ Policies on Nurse Practitioners as Primary Care Providers: Two Years Later
Results of NNCC’s Managed Care Credentialing Survey Indicate That the Healthcare Landscape is Changing,
But Many Insurers Still Do Not Recognize Nurse Practitioners as Primary Care Providers
by Anne Ritter
The following is an abridged summary of the

ered to be the equal of physicians in their
role as primary care provider, and are not
treated equitably by many insurers.
Among plans that credential NPs
as primary care providers:
zz Only 56% reimburse NPs at the same rate
as physicians, even though NP primary
care providers offer essentially the same

In addition, NNCC will begin to coordinate a series of free and low-cost webinars
for health centers, the first of which will

policymakers so that they are aware of the

Providing technical assistance to members

feature NNCC’s Nurse-Attorney Consultant

challenges that restrictive insurer policies

In addition to individualized technical as-

Sandra Berkowitz sharing her expertise

can pose to our members and the vulner-

sistance to our members, NNCC will also

about insurer contracting and credential-

able communities that they serve. In 2007

offer webinars and live workshops about

ing issues. It is slated to take place in June

and 2008, NNCC worked with members in

managed care contracting and reimburse-

2009. All NNCC members will receive addi-

Pennsylvania to educate state lawmakers

ment issues (as well as a wide variety of

tional information about these training op-

about restrictive insurer policies, especially

other topics) to a broader audience through

portunities in the near future. Please keep

in light of a significant proposed merger

the Health Center Empowerment Project,

your eyes open for more information about

between Highmark, Inc. and Independence

a multi-year project funded by the HRSA

event and webinar registration!

Blue Cross. In Pennsylvania, Highmark has

Bureau of Primary Health Care.

If you have any questions about the

been resolutely opposed to credentialing

The Health Center Empowerment Project

Health Center Empowerment Project or any

NPs as primary care providers, and this posi-

officially kicked off on February 24, 2009,

other issues regarding insurer credentialing

tion would be potentially devastating to our

with the Northeastern Regional Workshop

and reimbursement, please contact Ann Rit-

members if it were adopted statewide after

Project. The event, which was held at Inde-

ter at aritter@nncc.us or 215.731.7142.

NNCC-Member Peer Review Articles:
zz A White Paper was published by Disease

zz Sullivan-Marx, E. M., & Gray-Miceli,

Management, a peer-reviewed academic

D. (Eds.) (2008). Leadership and Man-

Sigma Theta Tau International published

journal, edited by Dr. David Nash of Jef-

agement Skills for Long Term Care. New

a book entitled: “Conversations with Lead-

ferson University Medical School, pub-

York: Springer.

ers,” co-authored by PHMC Board member,

Books

lished by Mary Ann Liebert, Inc. NNCC

zz Mackey, T. (2008). Practice management

Susan Sherman, Vernice Ferguson and Tine

co-authors include: Ken Miller, Mona

challenges for advanced practice nursing.

Hansen-Turton. Book signings took place at

Counts and Tine Hansen-Turton.

Clinical Scholars Review, 1(1), 11.

the NNCC annual conference and in Balti-

zz Sullivan-Marx, E.M., Cuesta, C. L., &

zz Mackey, T. (2008). Marketing your nurse-

Ratcliffe, S. J. (2008). Exercise among

managedpractice:becomea“marketpreneur”.

urban dwelling older adults at risk for

Clinical Scholars Review, 1(1), 13-17.

more on November 3, 2007.

health disparities. Research in Gerontological Nursing, 1, 1-10

www.NNCC.us p 41

NNCC UPDATE
Capstone Rural Health Center: A Leader in Technology
by Ann Ritter
Capstone rural health center began using Encite Electronic Medical Records around May of 2004. Some of the adversities faced were keeping communication flowing between client and vendor, having realistic expectations and allowing for a learning curve. The hiring of Matthew Mauldin
as Manager of area computing services has been an asset because he has invested the required time needed to configure the EMR to the clinic’s
practice. Matt expects to see areas of improvement in instant access to patient charts, legible charts, decrease in clinical errors, improved staff
communication, reduced overhead in charting expenses, increased reimbursement and improved statistical tracking of all areas of the clinic. Despite hesitation because of the possibility of information being left on screen and the possibility of patients attempting to damage the systems,
a wall-mounted workstation for charting purposes only was installed in all seven patient rooms. The reservations once present have now been
pushed aside after seeing the nursing staff charting in the rooms and building more of a bond with the patients. David Jones, nurse practitioner,
states, “Being able to chart electronically in the room gives us more access to the point of care, in other words we do everything right with the
patient. The patients feel a better sense of involvement in their care when we can work through the documentation with them.”
Read Matthew Mauldin’s article below for a staff perspective of what it takes to implement electronic health records…